Hitachi America HR Advisor With Cardiac Stent Stenosis Wins Florida Lincoln Financial Long-Term Disability Insurance Appeal After Denial at 24 Months

Lincoln Financial terminated our client’s long-term disability benefits at the 24-month mark — after two full years of agreeing he was too disabled to perform his own sedentary occupation as a Human Resources Advisor at Hitachi America in Florida. Our client suffers from cardiac stent stenosis and multiple spinal and neurological conditions, including cervical radiculopathy and bilateral carpal tunnel syndrome. Nothing in his medical record had improved. Lincoln simply decided he could now work full-time at the sedentary level.

We have handled thousands of Lincoln Financial disability claims, and this pattern is one we know well. Lincoln pays benefits for 24 months under the own-occupation standard, then uses the definition change to any occupation as a trigger to cut claimants off — often relying on a single paper review to justify the decision. Our client’s case was no different, and our office was prepared to dismantle every piece of Lincoln’s rationale.

Attorney Stephen Jessup filed a comprehensive appeal that produced new, independent medical evidence Lincoln had never obtained — and Lincoln reversed its denial in full. Below, we break down how the appeal was built, what evidence made the difference, and what every Lincoln Financial claimant approaching the 24-month mark needs to understand. If Lincoln Financial or any other disability insurance company has denied your long-term disability benefits, speak with one of our disability insurance lawyers for a free consultation. We represent claimants nationwide, and there is no fee unless your benefits are paid.

Table Of Contents

• 1. Why this case matters for every Lincoln Financial claimant
• 2. Lincoln’s denial: a paper review, a Transferable Skills Analysis, and a foregone conclusion
• 3. The FCE: below sedentary on every relevant measure
• 4. What the medical records actually show
• 5. The neuropsychological evaluation: severe cognitive deficits Lincoln never assessed
• 6. A Transferable Skills Analysis built on inflated assumptions
• 7. Lincoln reverses in full
• 8. Denied at 24 months by Lincoln Financial or any disability insurance company?

Why This Case Matters for Every Lincoln Financial Claimant

A paper review is not a medical examination — and the appeal proved it. A file review — sometimes called a paper review — is an assessment in which a physician reviews medical records without ever examining the claimant or speaking with their treating providers. Lincoln based its entire denial on exactly that kind of review, conducted by Dr. Kien Tran, a board-certified internal medicine physician who never examined our client and never spoke with a single one of his treating providers. When our office obtained an actual, in-person Functional Capacity Evaluation, the results directly contradicted Dr. Tran’s conclusions. If your denial rests on a paper review, that gap between what a reviewer assumes and what an in-person evaluation reveals is often where an appeal is won.

Lincoln ignored the cognitive demands of the occupations it claimed our client could perform. Every occupation identified in the Transferable Skills Analysis — including our client’s own position as a Human Resources Advisor — requires upper-level reasoning, language, and decision-making abilities. Lincoln never assessed our client’s cognitive functioning. A neuropsychological evaluation obtained on appeal revealed severe deficits in memory, visuospatial processing, and executive functioning that made those occupations impossible. For claimants with heart disease, vascular conditions, or any condition that may affect cognition, this is a critical lesson: physical capacity is only half the equation.

Two years of agreeing someone is disabled from a sedentary job — and then concluding they can do sedentary work — demands an explanation Lincoln could not provide. Lincoln paid benefits for 24 months under the own-occupation standard, acknowledging our client could not perform his sedentary HR Advisor role. At the definition change, Lincoln concluded he could perform other sedentary occupations — with no documented medical improvement. That logical contradiction became a powerful argument on appeal.

Assumptions baked into a Transferable Skills Analysis can be challenged — and should be. The TSA in this case inflated our client’s vocational profile by adjusting his General Education Development scores based on his master’s degree and inserting “no restrictions and limitations” where none had been established by a treating physician. Those unsupported inputs artificially broadened the range of occupations he was supposedly capable of performing. If you have been denied based on a TSA, every assumption in that analysis should be scrutinized.

Lincoln’s Denial: A Paper Review, a Transferable Skills Analysis, and a Foregone Conclusion

Our client worked as a Human Resources Advisor for Hitachi America, a position classified at the sedentary exertional level by the Department of Labor’s Dictionary of Occupational Titles. His responsibilities included analyzing and interpreting business information, speaking to large groups, making decisions based on personal experience and judgment, planning long-range projects, directing the work of others, and dealing with people across diverse interests. He stopped working due to lumbosacral intervertebral disc disorder, cardiac stent stenosis, bilateral carpal tunnel syndrome, and cervical radiculopathy, among other conditions. Following the elimination period — the initial waiting period a claimant must satisfy before long-term disability benefits become payable — Lincoln approved his claim and began paying long-term disability benefits under the own-occupation standard.

A long-term disability policy’s definition of disability typically changes at the 24-month mark — and understanding what happens when disability benefits change from own occupation to any occupation is critical for every claimant approaching that milestone. Under the own-occupation standard, the question is whether the claimant can perform the material and substantial duties of their specific job. Under the any-occupation standard, the question shifts to whether the claimant can perform the duties of any occupation for which they are reasonably fitted by training, education, experience, age, and physical and mental capacity. This definition change is the single most common trigger for benefit terminations across the insurance industry, and Lincoln Financial is among the most aggressive in using it.

Lincoln’s denial rested on two components. First, a file review completed by Dr. Kien Tran, a board-certified internal medicine physician. Dr. Tran reviewed the medical records and concluded our client could perform work at a sedentary demand level. He never examined our client. He never spoke with any of our client’s treating physicians. He never evaluated our client’s cognitive functioning. His review acknowledged an extensive list of diagnoses — thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders, cardiac stent stenosis, bilateral carpal tunnel syndrome, cervical radiculopathy, and hyperlipidemia — and yet reached a conclusion that contradicted two years of Lincoln’s own disability determination. Lincoln’s denial letter stated that based on its review, “you will not be eligible for benefits beyond November 3, 2025” — a date that marked exactly 24 months from the start of benefits.

The Restrictions Dr. Tran Assigned

Dr. Tran did acknowledge that our client’s conditions warranted physical restrictions, assigning the following limitations:

• Sitting: unrestricted
• Standing and walking: occasionally
• Lifting, carrying, pushing, and pulling: occasionally, up to 10 pounds
• Climbing stairs, balancing, stooping, kneeling, crouching, and crawling: occasionally
• Fine manipulation and simple/firm grasping: frequently
• No climbing ladders, no working at unprotected heights, no operating heavy machinery

On paper, these restrictions appear to fit within the sedentary demand level. But there was a fundamental problem: they were built entirely on a paper review. Dr. Tran had no basis for concluding our client could sit without restriction — because he never tested it. As the Functional Capacity Evaluation would later demonstrate, our client could sit for a maximum of only 10 minutes at a time and a total of two hours and 30 minutes per day. Sedentary work requires at least six hours of sitting per day. Dr. Tran’s “unrestricted sitting” designation was an assumption, not a fact — and it collapsed the moment real-world testing was applied.

The Transferable Skills Analysis

Second, Lincoln relied on a Transferable Skills Analysis completed by Jason M., M.Ed., CRC, ABVE/F, a vocational expert. Based on Dr. Tran’s restrictions, the TSA identified six sedentary occupations our client was purportedly capable of performing:

• Manager, Employment (DOT 166.167-030)
• Manager, Personnel (DOT 166.117-018)
• Employee Relations Specialist (DOT 166.267-042)
• Employment Interviewer (DOT 166.267-010)
• Personnel Recruiter (DOT 166.267-038)
• Supervisor, Payroll (DOT 215.137-014)

Every one of these occupations falls at the sedentary demand level. And every one of them requires cognitive abilities — reasoning, decision-making, mathematical processing, language comprehension — that Lincoln never evaluated. The denial was built on physical capacity alone, with no consideration of whether our client could actually perform the mental demands of the work.

The FCE: Below Sedentary on Every Relevant Measure

A Functional Capacity Evaluation is a comprehensive, standardized assessment that objectively measures a person’s physical ability to perform work-related tasks. It is the gold standard for determining what level of physical work a person can safely and dependably sustain. Lincoln never ordered one. So we did.

Our client underwent a comprehensive two-hour FCE based on the Dictionary of Occupational Titles–Residual Functional Capacity Battery, which tests over 30 different job-related tasks — climbing, balancing, stooping, crouching, crawling, walking, kneeling, and others — against peer-reviewed norms known as the Demand Minimum Functional Capacity. The DMFC represents the minimum acceptable level of performance a person must achieve for each job-related task before being able to safely and dependably return to work.

Sitting, Standing, and Walking Tolerances

The results were unequivocal. Our client could sit for only 10 minutes at a time, reporting significant pain and discomfort and shifting frequently in his chair to manage symptoms. He could stand for only 10 minutes at a time, experiencing significant pain, discomfort, and observable fatigue. He could walk for up to 10 minutes at a time before pain and fatigue limited him further. A Less Than Sedentary classification means a person cannot sustain even a desk job — they fall below the minimum physical threshold required for the lightest category of work recognized by the Department of Labor.

To put these numbers in context, sedentary work requires the ability to sit for at least six hours per day, stand and walk for a combined total of two hours per day, and lift or carry up to 10 pounds for up to two and a half hours per day. Our client demonstrated the capacity to sit for a maximum of two hours and 30 minutes per day and to stand or walk for a combined maximum of 55 minutes per day. He was capable of exerting up to five pounds at a time and could only occasionally lift lightweight items such as docket files, ledgers, and small tools.

Cardiovascular Response

The FCE also documented a concerning cardiovascular response during testing. Our client’s blood pressure increased from 134/88 mmHg at rest to 145/90 mmHg during functional activity, and his heart rate rose from 78 beats per minute to 112 bpm — a 34 bpm increase during maximal exertion. Most notably, his blood pressure dropped below resting levels after completing functional activities. That finding — blood pressure falling below baseline following exertion — indicates the body cannot sustain even basic physical demands. For a person with a history of cardiac stent stenosis, cardiac stent replacement, and restenosis, this was significant clinical evidence that Lincoln had never obtained.

The evaluating physical therapist concluded that our client fell within a Less Than Sedentary physical demand level — unable to work in any capacity, including at the sedentary level.

What the Medical Records Actually Show

The appeal did not rely solely on the new evidence obtained by our office. The treating medical records — records that were already in Lincoln’s file — consistently documented objective findings that supported ongoing restrictions and limitations. Attorney Jessup compiled the relevant medical evidence chronologically to demonstrate a clear pattern of impairment across multiple body systems.

Cervical Spine: Persistent Pain, Limited Motion, and Nerve Compression

Repeated examinations documented limited range of motion of the cervical spine in flexion, extension, and rotation, with tenderness, guarding, and spasm in the bilateral cervical paraspinals. An MRI of the cervical spine revealed postoperative changes from a prior fusion at C4–C7 with anatomic alignment at the operative levels, but significant degenerative changes at adjacent segments. At C3–C4, hypertrophy of the right uncovertebral joint with posterior osteophyte caused significant right foraminal stenosis — meaning narrowing of the nerve passageway with probable impingement upon the right C4 nerve root. At C4–C5, C5–C6, and C6–C7, the fused levels showed uncovertebral and facet joint hypertrophy with moderate bilateral foraminal stenosis at each level. In practical terms, these findings mean the nerve pathways exiting the spine are being compressed at multiple levels, producing pain, numbness, and weakness that radiates into the arms and hands.

Lumbar Spine: Painful Range of Motion with Nerve Root Irritation

Examination of the lumbar spine revealed painful range of motion in extension, tenderness over the left lumbar paraspinals and left posterior superior iliac spine, and a positive straight leg raise test on the left side. A positive straight leg raise test is a clinical indicator of nerve root irritation in the lower back. An X-ray of the lumbar spine confirmed an increase in lumbar lordosis, facet arthropathy (degeneration of the spinal joints), and calcification of the abdominal aorta.

Cardiac History: Stent Replacement, Restenosis, and Ongoing Monitoring

Our client had a history of cardiac stent stenosis — the narrowing or re-blockage of a coronary artery stent — requiring cardiac catheterization and coronary stent placement. An EKG study revealed sinus bradycardia (an abnormally slow heart rate), a rightward shift in QRS axis compared to prior studies, and shortened QT interval. An echocardiogram revealed discrete upper septal hypertrophy without evidence of left ventricular outflow tract obstruction. The consulting physician’s review in Lincoln’s own file acknowledged that the diagnosis of hyperlipidemia and cardiac stent stenosis was impairing because hyperlipidemia is a risk factor for cardiac stent stenosis, and our client had a history of cardiac stent replacement and restenosis. Yet Lincoln still concluded he could work full-time.

Bilateral Carpal Tunnel Syndrome and EMG Findings

An EMG and nerve conduction study revealed moderate bilateral carpal tunnel syndrome, consistent with the complaints of numbness and tingling in both hands that our client reported. The consulting physician’s review confirmed that the diagnosis of bilateral carpal tunnel syndrome was impairing because of these complaints, and that our client would require restrictions for simple and fine manipulation. These are the very hand functions required in every sedentary occupation identified in the TSA — recording figures, operating calculators, reviewing documents, reading and copying numbers.

Brain MRI: White Matter Changes Consistent with Chronic Vascular Disease

An MRI of the brain without contrast revealed scattered nonspecific white matter T2 hyperintensities — areas of abnormal signal in the brain’s white matter — which were noted to likely reflect chronic microvascular ischemic disease and/or sequelae of migraine headaches. In plain terms, this finding indicates that small blood vessels in the brain have been damaged over time, a process associated with the same vascular conditions — hypertension, hyperlipidemia, coronary artery disease — that underlie our client’s cardiac history. These white matter changes are clinically significant because they can contribute to cognitive decline, a finding the neuropsychological evaluation would confirm.

The Neuropsychological Evaluation: Severe Cognitive Deficits Lincoln Never Assessed

This is where Lincoln’s denial fell apart most decisively. Lincoln’s entire analysis focused on whether our client could physically perform sedentary work. It never once addressed whether he could cognitively perform the occupations the TSA identified. Attorney Jessup obtained a comprehensive neuropsychological evaluation to fill that gap.

Our client underwent a full neuropsychological evaluation with a board-certified neuropsychologist at a major neuroscience institute. The evaluation formally assessed emotional, behavioral, and cognitive functioning through a comprehensive battery of standardized tests — from intelligence measures and memory scales to executive functioning assessments, motor coordination tasks, and personality inventories. Our client reported a wide range of cognitive complaints, including:

• Short-term memory loss and forgetfulness with names, conversations, and appointments
• Poor attention and concentration
• Difficulty multitasking, planning, and organizing
• Poor decision-making and judgment
• Confusion, agitation, and difficulty thinking clearly

Test Results: Deficits Across Multiple Cognitive Domains

The testing revealed deficits spanning nearly every cognitive domain relevant to occupational functioning. To understand the significance of these scores, “Borderline” indicates performance below what would be expected, “Mild” indicates a noticeable deficit, “Moderate” indicates a clinically meaningful impairment, and “Severe” indicates performance so far below normal that the person would be unable to perform tasks requiring that ability in a work setting.

The most critical findings included:

• Verbal learning and memory: Short delay recall and total recall of rote verbal material scored in the Severe range — our client could not reliably retain or retrieve spoken information after even a brief delay
• Visual spatial learning and memory: Delayed visuospatial recall, immediate and delayed recall of complex visual spatial material all scored in the Severe range — he could not retain or reproduce visual information
• Complex spatial ability: Scored in the Severe range
• Fine motor coordination: Clinically significant deficits bilaterally — consistent with the bilateral carpal tunnel syndrome documented on EMG
• Language functioning: Phonemic verbal fluency scored in the Borderline range, confrontational naming in the Mild range
• Executive functioning: Conceptual reasoning and cognitive flexibility scored in the Borderline Low Average range, with set-shifting and preservation in the Moderate range
• Processing speed: Speeded word reading ability scored in the Mild range, speeded color naming in the Borderline range

Diagnosis: Major Neurocognitive Disorder

The evaluating neuropsychologist concluded that our client’s neurocognitive profile met DSM-5-TR criteria for Major Neurocognitive Disorder due to Multiple Etiologies without behavioral disturbance. Major Neurocognitive Disorder is a clinical diagnosis indicating that cognitive decline has progressed to the point where it interferes with the ability to carry out everyday activities independently — including occupational duties. The contributing conditions included a history of hyperlipidemia, hypertension, coronary artery disease, and carotid artery disease, along with mood disorder. The neuropsychologist noted that the likely interaction between vascular-related conditions and psychological factors was contributing to the cognitive difficulties, and that elevated scores on personality and mood inventories indicated high levels of emotional instability, depression, anxiety, and somatic concerns — all of which compounded the impact on concentration and memory.

Every occupation in Lincoln’s TSA requires upper-level reasoning, mathematics, and language abilities. Our client scored in the Severe range on multiple measures of memory and visuospatial processing, in the Moderate range on executive functioning and verbal recall, and demonstrated clinically significant bilateral fine motor deficits. The neuropsychological evaluation did not merely support the appeal — it made Lincoln’s TSA occupations objectively impossible.

A Transferable Skills Analysis Built on Inflated Assumptions

Attorney Jessup’s appeal also challenged the methodology of the TSA itself. A Transferable Skills Analysis is a vocational assessment that identifies alternative occupations a claimant may be capable of performing based on their physical abilities, cognitive abilities, and vocational profile. When a TSA is built on flawed inputs, its conclusions are unreliable — and the inputs in this case were flawed in multiple ways.

The TSA adjusted our client’s General Education Development profile — the reasoning, mathematics, and language skill levels used to match a person to appropriate occupations — upward to reflect 15–16+ years of education based on his master’s degree. But a master’s degree does not automatically confer upper-level proficiency in all three GED areas. The adjustment assumed what it needed to prove. In addition, the TSA inserted “no restrictions and limitations” in the environmental and physical aspects of the vocational profile where none had been provided by a treating physician. The absence of stated restrictions is not the same as the absence of restrictions — it simply means no physician was asked. Those unsupported inputs artificially expanded the range of occupations our client was deemed capable of performing.

We have seen this approach repeatedly in Lincoln Financial claims. When the vocational analysis is built on the foundation of a paper review that overstates physical capacity and a profile that inflates cognitive and educational assumptions, the resulting list of “available occupations” has no connection to what the claimant can actually do. We reversed a similar Lincoln Financial denial for a claimant with back disorders, fibromyalgia, and migraines who was denied at the 24-month definition change, and we reversed another Lincoln denial for a Florida attorney with carpal tunnel syndrome whose occupation had been misclassified. The pattern is consistent: Lincoln’s denials at the definition change rely on inputs that do not survive scrutiny when independent evidence is obtained.

Lincoln Reverses in Full

Attorney Stephen Jessup assembled the appeal and submitted it to Lincoln’s Disability and Life Claims Appeal division under the Employee Retirement Income Security Act of 1974 (ERISA), which governs most employer-sponsored long-term disability plans and provides a 180-day deadline for filing an administrative appeal after a claim denial. The appeal package included the Functional Capacity Evaluation, the neuropsychological evaluation, updated medical records from our client’s treating providers, and a detailed legal argument dismantling each element of Lincoln’s rationale.

Lincoln’s Claim Resolution Specialist, Darrell H., confirmed that Lincoln had completed its review and determined that benefits were payable. Our client’s file was returned to his case manager for continued handling, and all back benefits owed were to be paid. This was not an isolated outcome — we secured a similar reversal for a patient care coordinator whose Lincoln Financial benefits were denied during the transition from short-term to long-term disability.

As attorney Jessup wrote in the appeal, “Lincoln had previously determined that [our client] was disabled from his own Sedentary occupation for two years, and has now determined, without any indication of meaningful improvement in his health status that would see him return to work, that he is now capable of full time Sedentary work. We disagree and the medical records clearly support ongoing restrictions and limitations that would prevent him from Sedentary work.” Lincoln ultimately agreed.

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Denied at 24 Months by Lincoln Financial or Any Disability Insurance Company?

If Lincoln Financial or any other disability insurance company has denied your long-term disability benefits at the 24-month definition change, you have the right to appeal — but the deadline is strict, and the evidence you submit on appeal may be the last evidence considered before your only remaining option is a federal lawsuit. Do not rely on the same records that were already in the insurer’s file. The difference between a denied appeal and a reversal is often the independent medical evidence — an FCE, a neuropsychological evaluation, updated treating physician opinions — that fills the gaps the insurer exploited.

Our firm has represented tens of thousands of disability insurance claimants since 1979 and has recovered more than two billion dollars in benefits. We handle Lincoln Financial claims and appeals nationwide, and we understand exactly how Lincoln builds its denials at the definition change and how to take them apart. To protect your Lincoln Financial disability benefits or to discuss your denial, speak with one of our long-term disability insurance attorneys for a free consultation. There is no fee unless your benefits are paid.